NPIMap

Organization Active NPI

Stephen a. Wagner DDS,PC

  • Dental Clinic/Center
  • Albuquerque, NM
National Provider Identifier
1932332285
Registry record updated Sep 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
DD1150 Issued in NM
Legal business name
STEPHEN A. WAGNER DDS,PC
Practice address
801 Encino PL NE Ste A3
Albuquerque, NM 87102-2639
Phone
(505) 232-3588
Fax
(505) 232-3593
NPI assigned
Sep 2, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Stephen A Wagner, DDS,PCNPI 1336131267
Title
Maxillofacial Prosthodontist
Phone
(505) 232-3588

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X DD1150 NM Primary

Addresses

Primary practice location

801 Encino PL NE Ste A3
Albuquerque, NM 87102-2639

Mailing address

801 Encino PL NE Ste A3
Albuquerque, NM 87102-2639
Phone (505) 232-3588

Other identifiers 1

IdentifierTypeStateIssuer
82743MedicaidNM

National Provider Directory

National Provider Directory

Locations

801 Encino Pl NE
Ste A3
Albuquerque, NM 87102
Phone (505) 232-3588

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251849600000",
    "number": "1932332285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 ENCINO PL NE STE A3",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871022639",
            "telephone_number": "505-232-3588",
            "fax_number": "505-232-3593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 ENCINO PL NE STE A3",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871022639",
            "telephone_number": "505-232-3588",
            "fax_number": "505-232-3593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN A. WAGNER DDS,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-02",
        "last_updated": "2009-09-02",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MAXILLOFACIAL PROSTHODONTIST",
        "authorized_official_telephone_number": "505-232-3588",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS,PC"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NM",
            "license": "DD1150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "82743",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.